Should psychologists be able to prescribe medication?

If past performance is any indication, legislation allowing trained psychologists to prescribe medication to patients, rather than referring them to psychiatrists or physicians, is unlikely to become law in the near future despite an Illinois Senate committee's unanimous approval last month.

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By Lauren Leone-CrossGateHouse News Service

The Carmi Times - Carmi, IL

By Lauren Leone-CrossGateHouse News Service

Posted Apr. 5, 2013 at 10:00 PM

By Lauren Leone-CrossGateHouse News Service

Posted Apr. 5, 2013 at 10:00 PM

If past performance is any indication, legislation allowing trained psychologists to prescribe medication to patients, rather than referring them to psychiatrists or physicians, is unlikely to become law in the near future despite an Illinois Senate committee's unanimous approval last month.

The concept is fairly uncharted territory in the United States. Since 1995, just two states — New Mexico and Louisiana — have extending such rights to psychologists. Over that same period, 169 bills have failed in 26 states, with 14 failed attempts in Illinois alone, according to data from a national organization of psychologists opposing the legislation.

A major sticking point in the long-standing debate is whether psychologists are qualified to prescribe medication without completing medical school.

400 hours vs. 4 years

Michele Womontree, a clinical psychologist in Springfield who supports the concept, said psychologists undergo extensive training to obtain their doctorates, including four years of undergraduate courses. Graduate students are required to complete internships amounting to a minimum of 1,500 hours. Another one-year, full-time internship is required before obtaining a degree.

They also have to complete one year of post-doctoral training in their specialized field and pass a nationally recognized exam before getting a license.

"So that's where we start when you come to this prescription privilege. I think people underestimate the amount of training we already undergo," Womontree said. "I think the preparation … would have the psychologist better prepared than many of the current prescribers."

With additional training, psychologists could safely prescribe because of their combined expertise in behavioral and social causes of mental health issues, as well as psychopharmacology (the study of how psychiatric medicine works with the body), said Dr. Beth Rom-Rymer, president of the Illinois Psychological Association.

Rom-Rymer is leading the legislative effort for RxP Illinois, a group of mental health-care professionals led by IPA.

Under Illinois' latest proposal — sponsored by Sen. Don Harmon, D-Oak Park, and backed by the American Psychological Association — prescribing psychologists would have to earn a master's degree in psychopharmacology in addition to their doctorate.

Psychologists would also have to undergo 80 hours of supervised clinical assessment training and pathophysiology and complete at least 400 hours of supervised treatment of no fewer than 100 patients with mental disorders.

Experience counts

Psychiatrists, on the other hand, have to complete four years of medical school, a four-year residency program and another two years if they want to specialize in a particular area. In that time, psychiatrists-in-training could come across thousands of patients while supervised by experienced clinicians, said Dr. William Werner, president of the Illinois State Medical Society.

Page 2 of 4 - "To have that hands-on experience, to have that interaction with patients is so important. The concern is that psychologists have not had that clinical experience," Werner said. "You need years of experience in terms of knowing how these drugs will work in the body, how they're eliminated from the body and how they interact with other medications."

Prescribing psychologists would be practicing medicine without ever setting foot in a hospital, said Tim Tumlin, a clinical psychologist and member of Psychologists Opposed to Prescription Privileges for Psychologists.

Another opponent, Dr. Lisa Rone, assistant clinical professor of psychiatry at Northwestern and former president of the Illinois Psychiatric Society, said if psychologists want to prescribe, the solution is simple: "Go to medical school."

But Rom-Rymer argues that psychologists could potentially surpass psychiatrists in the total number of hours of clinical experience in the diagnosis and treatment of mental health disorders with additional training. Psychologists who have received this training over the past several years to practice in New Mexico and Louisiana have done so without incidences of malpractice, she added.

Rone said there's not enough data available for RxP Illinois to make that claim.

"We have to remember, there's a small number of prescribing psychologists (in those states)," Rone said.

According to data provided by Rom-Rymer, there are 64 prescribing psychologists in Louisiana and 25 in New Mexico.

Issue of access

As mental health funding in Illinois is slashed year after year, down nearly 32 percent from 2009, supporters believe SB 2187 could lead to greater access to services in underserved communities.

Womontree said she recalls some rural patients driving 60 miles one way just for counseling. Then, she said, they would have to make a second trip to see a psychiatrist.

"If one person can fully assist an individual, there's less opportunity for them for fall through the cracks," Womontree said. "Someone might not have the strength to follow through. People are often seeking mental health services when they're not at their strongest."

But this legislation does not address access issues, Werner said. Just as psychiatrists do, psychologists gravitate toward more densely populated areas. The greater distances between health-care facilities and fewer academic programs graduating these professionals make rural areas less attractives.

"Some of it also has to do with lifestyle," Werner said. "In bigger cities, they work in shifts. In smaller towns and rural areas in the state, you're on call 24 hours a day."

In general, Illinois is also not a "conducive environment" for those who want to practice medicine, especially now with legislation calling for a doubling of doctors' licensing fees, he said.

"I had a student ask me a couple of weeks ago, 'Why would anyone want to practice here?'" Werner said.

Page 3 of 4 - The number of licensed psychiatrists in Illinois declined 21 percent between 2007 and 2012, according to the American Psychological Association Practice Organization.

However, data compiled by the Illinois Hospital Association shows an 5.7 percent increase in actively licensed physicians in Illinois between 2008 and 2012, making up about 12 percent of total health-care professionals as of January 2012. Psychiatrists, who are physicians specializing in the treatment of mental disorders, are included in that category.

Actively licensed psychologists, on the other hand, increased by 16 percent during the same period, making up 1.3 percent of total health-care professionals as of January 2012.

Rom-Rymer noted that of the 46 counties without a psychiatrist, 24 had a psychologist, according to 2007 data.

Addressing shortages

Rone agreed rural communities are dealing with shortages, but said giving prescribing rights to the undertrained is not the way to go.

"We don't address an access issue by putting in people who can't actually do the job. We certainly need to work on ways to recruit more people to go to medical school," Rone said.

While the organization acknowledges serious shortages in the mental health professional workforce, Thomas said she doesn't believe the current legislation would address them.

"Rather than create a new credential and look at it piecemeal as one opportunity at this point in time, we'd really like for people to envision a system and look at it from every angle before making decisions on where the system should go," Thomas said.

Lucrative options

Psychologists in Illinois can already prescribe medication if they receive training as a nurse practitioner or physician's assistant, Tumlin noted.

Combined, actively licensed physicians, APNs and physicians' assistants — all of whom can prescribe at some level — rose 73.1 percent between 2007 and 2012 and account for 14.8 percent of health-care professionals in the state, according to IHA data.

"The problem is those options are not as lucrative as certain psychologists getting their hands on prescriptions pads," Tumlin said. "I assure you, prescribing drugs makes more money than doing psychotherapy."

On the other hand, Rom-Rymer said she thinks the legislation could reduce the number of people using prescription medication as the first line of treatment because psychologists specialize in alternative treatments.

Opponents maintain the legislation is just a way for psychologists to sidestep medical school.

"To come along and say people with basically a summer school course online are ready to prescribe … really reverses all of the work we've done. It really says it's OK to offer substandard care," Rone said.